ABSTRACT
BACKGROUND: Warm autoimmune hemolytic anemia (w-AIHA) is an uncommon disease with heterogeneous response to treatment. Steroids are the standard treatment at diagnosis, whereas rituximab has recently been recommended as the second-line therapy of choice. Our main objective was to document the response to treatment in patients with newly diagnosed w-AIHA, including the effectiveness of low-dose rituximab as frontline treatment and for refractory disease. METHODS: Patients with w-AIHA from 2002 to 2017 were included. Relapse-free survival (RFS), probability of maintained response (MR), and time-to-response were analyzed using the Kaplan–Meier method. Response was classified as complete, partial, and no response. RESULTS: We included 64 adults with w-AIHA (39 women and 25 men). The median age was 37 (16–77) years. Response rates to steroids alone were 76.7%, rituximab plus steroids, 100%; and cyclophosphamide, 80%. RFS with steroids at 6, 36, and 72 months was 86.3%, 65.1%, and 59.7%, respectively. Eighteen patients received rituximab at 100 mg/wk for 4 weeks plus high-dose dexamethasone as first-line therapy, with RFS at 6, 36, and 72 months of 92.3%, 58.7% and 44.1%, respectively. Eight patients refractory to several lines of therapy were treated with low-dose rituximab, and all achieved a response (three complete response and five partial response) at a median 16 days (95% confidence interval, 14.1–17.8), with a 75% probability of MR at 103 months; the mean MR was 81.93±18 months. CONCLUSION: Outcomes of w-AIHA treatment were considerably heterogeneous. Low rituximab doses plus high dexamethasone doses were effective for refractory disease.
Subject(s)
Adult , Female , Humans , Anemia, Hemolytic, Autoimmune , Cyclophosphamide , Dexamethasone , Diagnosis , Methods , Mexico , Rituximab , Splenectomy , SteroidsABSTRACT
Objective Standard dose of rituximab monodonal antibody(McAb)(375 mg/m2/week×4) has been recommended as a salvage regimen for refractory and recurrent warm autoimmune hemolytic anemia (wAIHA). The effect of low-dose rituximab in wAIHA needs more evaluation. Methods Through a compre-hensive literature search through PUBMED and CNKI databases, 13 articles of 172 cases were reviewed. Re-sults The current understanding of low-dose rituximab in wAIHA is limited. Based on the summary of these studies, the overall response rate was 87.8% with 62.8% complete response and 25% partial response. Since each study only enrolled several cases, the relapse rates markedly varied from 0 to 62.5%. Nevertheless, re-treatment of low-dose rituximab was still effective in some relapsed patients. No significant adverse event was reported. Conclusions Present literature analysis suggests that low-dose rituximab could be an effective and safe therapy for wAIHA.
ABSTRACT
Objective Standard dose of rituximab monodonal antibody(McAb)(375 mg/m2/week×4) has been recommended as a salvage regimen for refractory and recurrent warm autoimmune hemolytic anemia (wAIHA). The effect of low-dose rituximab in wAIHA needs more evaluation. Methods Through a compre-hensive literature search through PUBMED and CNKI databases, 13 articles of 172 cases were reviewed. Re-sults The current understanding of low-dose rituximab in wAIHA is limited. Based on the summary of these studies, the overall response rate was 87.8% with 62.8% complete response and 25% partial response. Since each study only enrolled several cases, the relapse rates markedly varied from 0 to 62.5%. Nevertheless, re-treatment of low-dose rituximab was still effective in some relapsed patients. No significant adverse event was reported. Conclusions Present literature analysis suggests that low-dose rituximab could be an effective and safe therapy for wAIHA.